Educational Enhancement

Current Articles

Economic diversity in medical education: the relationship between
students' family income and academic performance, career choice, and
student debt.

Cooter R, Erdmann JB, Gonnella JS, Callahan
CA, Hojat M, Xu G.

Jefferson Medical College.

Providing access to higher education across all income groups is a
national priority. This analysis assessed the performance, career choice,
and educational indebtedness of medical college students whose educational
pursuits were assisted by the provision of financial support. The study
looked at designated outcomes (academic performance, specialty choice,
accumulated debt) in relation to the independent variable, family
(parental) income, of 1,464 students who graduated from Jefferson Medical
College between 1992 and 2002. Students were classified into groups of
high, moderate, and low income based on their parental income. During the
basic science years, the high-income group performed better; however, in
the clinical years, performance measures were similar. Those in the
high-income group tended to pursue surgery, while those in the low-income
group preferred family medicine. The mean of accumulated educational debt
was significantly higher for the low-income group. The study provides
support for maintaining economic diversity in medical education.

Teaching, digression, and implicit curriculum.

BACKGROUND: Although medicine resides within contexts that have
historical, cultural, and societal determinants, these are rarely
addressed explicitly in current medical teaching. SUMMARY: The article
describes a method of teaching in which mainstream biomedical learning is
linked to digressions, which serve as the medium for considering the
contexts of medicine, unmasking hidden messages, and broadening the scope
of medical instruction. CONCLUSION: Teaching by digression encourages
students to learn core clinical science while considering such otherwise
neglected areas such as medical values, contexts, habits, and history.
Integrating this consideration of the hidden assumptions of medical
practice into mainstream medical learning allows students to understand
modern biomedicine as a system that is historically, culturally, and
socially conditioned.

BACKGROUND: When the University of Calgary implemented the clinical
presentation (CP) curriculum in 1994, it was prospectively decided to
administer the National Board of Medical Examiner's Comprehensive Basic
Science Exam (CBSE) as a measure of students' basic science knowledge
retention. PURPOSE: The exam performance from 2 classes (1995, 1996) of
the previous system-based (SB) curriculum was compared to exam performance
of 2 classes (2000, 2002) of the CP curriculum. METHODS: Data analyses
employed 2 statistical models (covariate multiple linear regression and
hierarchical mixed effects), and effect sizes were computed. RESULTS:
Differences between CBSE mean scores produced by students from the SB and
CP curricula showed a curricular effect on students' retention of basic
science knowledge. However, preexisting differences between groups were
found to be in the small-to-medium range. CONCLUSION: Evidence supporting
the potential of schemes within a CP curriculum and their relation to
basic science knowledge retention was observed. Effect size for the CP
curriculum on students' retention of basic science knowledge was
substantial; however, a notable part of that difference can be accounted
for by extraneous and confounding factors. Further research utilizing more
rigorous designs to investigate the relation between schemes and basic
science retention is warranted.

Evaluation of a surgical simulator for learning clinical anatomy.

Hariri S, Rawn C, Srivastava S, Youngblood P, Ladd A.

Department of Orthopaedic Surgery, Stanford University School of Medicine,
Stanford, CA 94305, USA.

BACKGROUND: New techniques in imaging and surgery have made 3-dimensional
anatomical knowledge an increasingly important goal of medical education.
This study compared the efficacy of 2 supplemental, self-study methods for
learning shoulder joint anatomy to determine which method provides for
greater transfer of learning to the clinical setting. METHODS: Two groups
of medical students studied shoulder joint anatomy using either a
second-generation virtual reality surgical simulator or images from a
textbook. They were then asked to identify anatomical structures of the
shoulder joint as they appeared in a videotape of a live arthroscopic
procedure. RESULTS: The mean identification scores, out of a possible
score of 7, were 3.1 +/- 1.3 for the simulator group and 2.9 +/- 1.5 for
the textbook group (P = 0.70). Student ratings of the 2 methods on a
5-point Likert scale were significantly different. The simulator group
rated the simulator more highly as an effective learning tool than the
textbook group rated the textbook (means of 3.2 +/- 0.7 and 2.6 +/- 0.5,
respectively, P = 0.02). Furthermore, the simulator group indicated that
they were more likely to use the simulator as a learning tool if it were
available to them than the textbook group was willing to use the textbook
(means of 4.0 +/- 1.2 and 3.0 +/- 0.9, respectively, P = 0.02).
CONCLUSION: Our results show that this surgical simulator is at least as
effective as textbook images for learning anatomy and could enhance
student learning through increased motivation. These findings provide
insight into simulator development and strategies for learning anatomy.
Possible explanations and future research directions are discussed.

Evaluating the impact of moving from discipline-based to integrated
assessment.

BACKGROUND: The move from discipline-based to problem-based learning (PBL)
at Adelaide University in 2000 offered exciting opportunities to integrate
the teaching and learning of the basic and clinical sciences for medical
undergraduates. However, several cohorts of students still needed to
progress through the first 3 years of the more traditional curriculum.
Paradoxically, their readiness to function in the integrated learning and
assessment environment of the last 3 years was assessed in 7 separate
discipline-based examinations at the end of third year. When considerable
examination-related stress was noted in the 1997 cohort and students
petitioned formally for a reduced examination load, it was considered to
be time for assessment to lead the way in integrating the disciplines.
AIM: After introducing third year integrated written assessments in 1998,
we aimed to develop an integrated practical examination (IPE) linking
theory to practice, and evaluate its impact on staff and students.
METHODS: After extensive staff collaboration, a structured objective
multistation IPE was developed and administered in 1999 and 2000. Its
utility was evaluated using a model proposed earlier. RESULTS: Assessment
validity was maximised by an extensive item review process. Reliability,
as measured by Cronbach's alpha, was 0.79 and 0.80 in 1999 and 2000,
respectively. An independent evaluation yielded qualitative data on the
examination's educational impact, cost and acceptability. CONCLUSIONS:
Investing time in changing from discipline-based to integrated assessment,
integrating theory and practice, resulted in gains in assessment
reliability, validity and educational impact on both staff and students.

Changing education, changing assessment, changing research?

Schuwirth LW, van der Vleuten CP.

Department of Educational Development and Research, University of
Maastricht, PO Box 616m, 6200 MD Maastricht, The Netherlands.
l.schuwirth@educ.unimaas.nl

BACKGROUND: In medical education, assessment of medical competence and
performance, important changes have taken place in the last 5 decades.
These changes have affected the basic concepts in all 3 domains.
DEVELOPMENTS IN EDUCATION AND ASSESSMENT: In education constructivism has
provided a completely new view on how students learn best. In assessment
the change from trait-orientated to competency- or role-orientated
thinking has given rise to a whole range of new approaches. Certain
methods of education, such as problem-based learning (PBL), and
assessment, however, are often seen as almost synonymous with the
underlying concepts, and one tends to forget that it is the concept that
is important and that a particular method is but 1 way of using a concept.
When doing this, one runs the risk of confusing means and ends, which may
hamper or slow down new developments. LESSONS FOR RESEARCH: A similar
problem seems to occur often in research of medical education. Here too,
methods--or, rather, methodologies--are confused with research questions.
This may lead to an overemphasis on research that fits well known
methodologies (e.g. the randomised controlled trial) and neglect of what
are sometimes even more important research questions because they do not
fit well known methodologies. CONCLUSION: In this paper we advocate a
return to the underlying concepts and a careful reflection of their use in
various situations.

Over the years we have observed that there is a very low passing rate for
the Anatomy and Neuroanatomy courses in our department, and for that
reason we decided to implement the use of student-learning resources. The
objective of this study was to compare the results of traditional
methodology with those obtained with the support of computer-assisted
learning (CAL). We performed a retrospective and joint study for Anatomy
and Neuroanatomy groups during the period of September 2001 to February
2003, to establish a comparison between traditional learning and
traditional learning supported by CAL. In the Anatomy group, students who
used the traditional method (n1 = 365) received an average final grade of
58 (SD = 14.94), while the average final grade for students who used the
traditional method supported by CAL (n2 = 283) was 68 (SD = 14.56). In the
Neuroanatomy group, the students who used the traditional method (n3 =
217) had an average final grade of 61 (SD = 14.51), while the students who
used the traditional method supported by CAL (n4 = 134) received an
average final grade of 68 (SD = 13.52). A z-test was conducted to
determine the difference in averages between the two groups (alpha =
0.05), and the results showed that the averages were significantly
different (P <.001). The modified traditional method with CAL support was
shown to be the best option in comparison with the traditional method.
Copyright 2004 Wiley-Liss, Inc.

Increasing active student participation in histology.

Black VH, Smith PR.

Department of Cell Biology at New York University School of Medicine, New
York 10010, USA. blackv01@med.nyu.edu

As have many institutions, the New York University School of Medicine (NYUSM)
has instituted curriculum revisions that allow for increased independent
study but impose significant time constraints on laboratory courses.
Challenged by decreased laboratory time, we sought creative solutions for
our histology course, "Cell Biology of Tissues and Organs," using
computer- and Web-based materials. While these solutions have facilitated
independent study, they have not fostered the subtler lessons learned in
the laboratory, such as communication skills and team approaches to
learning. To retain these elements and enrich our course, we focused on
increasing student participation in the laboratory through unit reviews
presented by students, student-generated comprehensive reviews, and
practice exams. The active engagement of students in the learning process
has resulted in a more exciting laboratory experience for all. Copyright
2004 Wiley-Liss, Inc.